Indian Journal of Surgery

https://doi.org/10.1007/s12262-019-01980-7

ORIGINAL ARTICLE

Are the operation theatres being optimally utilized? – A prospective

observational study in a tertiary care public sector hospital
Deepti Sahran 1 & Vijaydeep Siddharth 2 & Sidhartha Satpathy 3

Received: 23 January 2019 / Accepted: 27 August 2019

# Association of Surgeons of India 2019

Abstract
The study aimed to analyse the utilization of the operation theatres at a tertiary care teaching hospital. An observational
study with time monitoring of various processes was carried out from January to December 2016 in the OT complex of a
public sector tertiary care hospital. OT complex comprised of 12 operating rooms and all the elective OTs (11) were
included in the study except the emergency OT. One OT for a full day per week was observed. Selection of operation
theatre and weekday for data collection was done using simple random sampling without replacement using chit system.
OTs were observed for 26 days spread over a period of 6 months with resource hours of 15,000 min (250 h). A total of
129 (69.34%) surgeries out of 186 scheduled surgeries were conducted with an average of 4.61 surgeries per day and an
observed cancellation rate of 30.66%. Overall raw utilization of OT was observed to be 99.29%, while overall adjusted
utilization was 128.53% with an idle time of 0.81% only. Total time spent on Banaesthesia preparation^ was 1624 min
(8.42%), Bsurgical preparation time^ was 1930 min (10.01%), Bactual surgery time^ was 9554 min (49.56%), Broom set-
up and room clean-up time^ was 4441 min (23.04%), Bsurgery finish and anaesthesia finish time^ was 574 min (2.98%)
and Bturn over time^ was 1000 min (5.19%). The operation theatres are being optimally utilized, however, an effort
should be made to make the ancillary processes (room set up and clean up) more efficient.

Keywords Efficiency . Operation theatre . OT utilization . Major surgery . Minor surgery

Introduction recovery from anaesthesia, preparation of the OT for

the next patient and other resources [3, 4]. Optimal use
Operation theatre (OT) of a hospital is a human resource of OT time can greatly improve the efficiency of re-
intensive area equipped with sophisticated, specialized source utilization, decreased cancellation rates, help de-
and costly equipment [1]. In this specialized critical area, crease waiting lists for surgery, minimize OT time over-
effective coordination of doctors from different special- run with consequent reduction of overtime staff cost [3,
ties, nursing staff and various support services is essen- 5]. It also improves the flow of patients through the
tial to ensure its optimal utilization [2]. Effective utiliza- hospital, increases patient and staff satisfaction and can
tion of OT time depends on scheduling of cases, alloca- reduce the mental and financial burden on the patients
tion of staff, equipment, time required for preparation and their attendant [2, 3].
and induction of anaesthesia, performance of surgery, Operation theatre (OT) is one of the primary sources of
revenue generation in hospital, with around 50–60% of
revenue being generated by this facility alone. It also rep-
resents an area of considerable expenditure for any hospi-
* Vijaydeep Siddharth
dr.siddharthmamc@gmail.com
tal budget, hence, mandates efficient utilization to ensure
an optimal cost-benefit ratio [6]. As a premier public sec-
1
tor health care institution of the country, providing quality
Army Hospital (Research and Referral), New Delhi, India treatment at highly subsidized cost has led to tremendous
2
Department of Hospital Administration, All India Institute of workload at AIIMS causing demand supply mismatch.
Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India Study on OT utilization has been earlier carried out in
3
Department of Hospital Administration, AIIMS, New Delhi, India the year 2002 at AIIMS [7] in which nearly 26% of the
 Indian J Surg

Table 1 List of important terminologies used in OT utilization [9, 10]

Procedural times Scheduling terms Utilization and

efficiency indices

1. Room set-up 9. Procedure/surgery start time 1. Anaesthesia preparation 6. Room clean-up time 1. Adjusted utilization
start time (RSS) (PST/SST) time (APT) (RCT) (AU)
2. Room ready time (RR) 10. Procedure/surgery conclusion 2. Case time (CT) 7. Room set-up time 2. Early start
begun/time (PCB/SCT) (RST)
3. Patient in room time 11. Procedure/surgery finish time (PF/SF) 3. Early start hours (ESH) 8. Surgical preparation 3. Late start
(PIR) time (SPT)
4. Anaesthesia start time 12. Anaesthesia finish time (AF) 4. Overrun hours (OVRH) 9. Surgery time (ST) 4. Overrun
(AS)
5. Anaesthesia induction 13. Patient out of room time (POR) 5. Resource hours (RH) 10. Start time (StT) 5. Raw utilization (RU)
time (AI)
6. Anaesthesia ready 14. Room clean-up start time (RCS) 6. Room gap time
time (AR)
7. Position/prep start 15. Room clean-up finished time (RCF) 7. Idle time (IT)
time (PS)
8. Prep-completed time
(PC)

total cases posted in all the OTs were cancelled due to been conducted in India providing in depth analysis of the
unrealistic scheduling and shortage of OT time. Similar OT time utilization. Therefore, this study has been envis-
studies have been carried out in a tertiary care hospital aged to examine the utilization of Operation Theatres at
of Goa [8] and at PGIMER Chandigarh [4] in the year AIIMS Hospital, New Delhi through time motion study of
2010–2011. However, there is hardly any study which has various processes.

APT

StT
RST
RSS RR PIR AS AI

Utilisation
Raw
CT
SPT

ST
PCB/SCT PST/SST PC PS AR

RCT
TOT

PF/SF AF POR RCS RCF

nPIR

Fig. 1 Flow chart depicting important terminology and time interval used surgery start time; SPT, surgical preparation time; PCB/SCT, procedure/
in OT utilization [9]. Abbreviations used: RSS, room set-up start time; surgery conclusion begun/time; ST, surgery time; PF/SF, procedure/
RR, room ready time; RST, room set-up time; PIR, patient in room time; surgery finish time; AF, anaesthesia finish time; POR, patient out of room
StT, start time, AS, anaesthesia start time; AI, anaesthesia induction time; time; RCS, room clean-up start time; RCF, room clean-up finished time;
AR, anaesthesia ready time; APT, anaesthesia preparation time; PS, RCT, room clean-up time; CT, case time; nPIR, next patient in room time;
position/prep start time; PC, prep-completed time; PST/SST, procedure/ TOT, turnover time
Indian J Surg

rate of minor
Cancellation
Methodology

2 (16.67%)

5 (27.78%)
5 (50.00%)
3 (11.54%)
surgeries

15 (23%)
0 (0%)
0 (0%)

0 (0%)
An observational and descriptive study was carried out at
OT Complex of All India Institute of Medical Sciences,
Average minor
New Delhi hospital for a duration of one year, from

scheduled conducted conducted per

rate of major surgeries surgeries surgeries January–December 2016. The study commenced after
the approval of Ethics Committee was obtained. The ob-

51 (39.53%) 3.92
day

4.60
servations were not taken while the OT was partly func-

2.5

13
2

0
0

0
10 (29.41%)
tional during summer vacations to avoid any bias in the
23 (71.88%)
5 (26.32%)

13 (100%)
study findings. OT Complex consists of 12 OTs designed
Minor

0 (0%)
0 (0%)

0 (0%)
and equipped for conducting surgeries under general an-
aesthesia out of which 11 OTs are earmarked for elective
surgical cases of different specialities (General Surgery,
Cancellation Minor

G I S u r g e r y, P a e d i a t r i c S u r g e r y, O b s t e t r i c s &
12

18

66
26
10

0
0

0
Gynaecology, Urology and ENT) were included in the
study and one OT utilized for emergency cases was ex-
22 (47.83%)

2 (15.38%)
4 (20.00%)
8 (47.05%)
6 (30.00%)
surgeries

cluded from the study.

42 (35%)
0 (0%)
0 (0%)

One OT was observed for full working day, per week

over a period of 6 months. Simple random sampling
without replacement, using chit system, was carried
Average major

scheduled conducted conducted per

out for the selection of operation theatre and day of

rate of total surgeries surgeries surgeries

the week for the data collection. When all the 11 OTs
were studied, only then the second cycle of observation
3.67
2.67
day

3.50

78 (60.47%) 3.12
4
3

was started. The observations were not made on sun-

24 (70.59%)

14 (73.68%)
9 (28.12%)

16 (100%)

11 (100%)

days and gazetted holidays. If the selected observation

4 (100%)
Major

0 (0%)

day fell on a gazetted holiday, then the next working

day was utilized for observation for the selected OT.
OT utilization data (average number of surgeries performed & surgery cancellation rate)

The data was collected by a single observer using direct

Total Total number Total number Average number of Cancellation Major

non-participant observations and in-depth interactions

120
20

13
46
17
20

with staff working in OT (doctors/nursing staff/techni-

0

cians/hospital attendant/sanitary attendant etc.) to under-

24 (41.38%)

57 (30.65%)
11 (25.58%)
11 (36.67%)
4 (20.00%)

2 (15.38%)
5 (27.78%)
conducted per day surgeries

stand the various OT processes. The observer was a

0 (0%)

medical doctor and fully trained on the subject under

study.
Mapping of various OT processes was conducted i.e.
from time the patient is wheeled inside the operation
total surgeries

theatre till the patient is wheeled out of operation theatre.

The standard terminologies/definitions were used during
this observational study (Operational definitions attached
3.78

3.67
6.40
4.75

4.61
13
4

as Appendix) [9, 10] (Table 1 and Fig. 1). The data

collected was entered and analysed using Microsoft
obs. of surgeries of surgeries
conducted

Excel 2010. Descriptive statistical measures were

calculated.
129
34

16
32
19

13
11

4
scheduled

Results
186
58

20
43

13
30

18

The hospital in which this study has been carried out is

a 1100 bedded multispecialty hospital. The OT complex
28
9

2
5

3
4

is housed on the eighth floor (penultimate floor) along

Gynaecology

with OT recovery area and ICU, which is accessible

Specialty

GI surgery
Pain clinic

surgery
Paediatric
Table 2

Total (n)
Urology
Surgery

through lifts and staircase. OT working hours are from

ENT

8:30 AM to 5:00 PM from monday to friday and from

 Indian J Surg

Table 3 Reasons for cancellation of major and minor surgeries

S Reasons for cancellation for major Total number of Reasons for cancellation for Total number of
no. surgeries (n = 42) major surgeries minor surgeries (n = 15) minor surgeries
cancelled cancelled
Surgeon-related cancellation (73.8%) Surgeon-related cancellation (20%)

1 Lack of operating time due to improper scheduling 25 Patient operated in different OT than 3
the scheduled OT
2 Patient operated in different OT other than the 3
scheduled OT
3 Surgery Consultant was not available for surgery 1
4 Patient had HTN and no PAC was done, as his name 1
was added in OT list at midnight 1 day prior to
surgery
5 Patient name was deleted from final OT list on the 1
day of surgery without any reason being noted in
case file

Medical condition related cancellation (16.7%) Medical condition related cancellation (13%)
1 Case cancelled due to high BP of patient on OT table 2 Unfit for surgery due to medical problem 1
(low platelet count)
2 Patient had fungal infection at the surgical site, 1 Patient had tinea cruris 1
however, during part preparation patient developed
allergic reaction
3 Patient had respiratory tract infection 1
4 Patient was on aspirin till 2 days before surgery and 1
aspirin was to be stopped 5 days before surgery
5 Patient had cholecystitis 1
6 Being a high-risk case with AS & MR, Cardiologist 1
advised DVR. Anaesthetist felt there would be
more blood loss, hence cancelled

Patient related cancellation (7%) Patient related cancellation (40%)

1 Patient was unwilling for the surgery 1 Patient did not report for surgery 5
2 Patient had come but at his turn he was not traceable 1 Patient did not bring right size needle & it was 1
unavailable in hospital supply
3 Patient did not report for surgery 1

Administrative/logistics related cancellation (2.4%) Administrative/logistics related cancellation (6%)

1 Robotic surgery machine had developed a technical 1 Diagnosis mentioned on face sheet was wrong 1
fault in scheduled OT, hence case (actually patient was for DJ stent however patient
operated in other OT diagnosis was written as AV fistula)

Anaesthesia related cancellation (0%) Anaesthesia related cancellation (20%)

1 Nil 0 Cancelled by Anaesthetist for unknown reasons 3
Grand Total 42 15

8:30 AM to 1:00 PM on saturday and are functional in minor surgeries per day (Table 2). Out of 186 scheduled
two shifts. Emergency OT (OT 12) remains functional surgeries, 134 (72.04%) surgeries were planned and 52
round the clock. (27.96%) surgeries were unplanned. In 48 (37%) cases,
During the 26 OT observation days, 28 OT tables general anaesthesia was administered, in 23 (18%) cases
were observed. A total of 129 (69.34%) surgeries out general anaesthesia along with regional anaesthesia was
of 186 scheduled surgeries were conducted with an av- administered, 51 (40%) cases were performed under local
erage of 4.61 surgeries per day. Out of 129 surgeries anaesthesia and in only seven (5%) cases regional anaes-
performed, 78 (60.47%) were major surgeries with an thesia was administered. Out of the total 186 scheduled
average of 3.12 major surgeries per day and 51 surgeries, 57 (30.65%) surgeries were cancelled. In major
(39.53%) were minor surgeries with an average of 3.92 surgeries, out of 120 scheduled surgeries, 42 (35%)
Indian J Surg

Fig. 2 Average percentage time Room clean up me

taken in various processes in 3%
operating time 5% 10% Room set up me

Anaesthesia preparaon me

13%
Surgery preparaon me

8% Surgery me

50% Surgery finish me and

10% anaesthesia finish me (in min)
Turn over me

Idle me

surgeries were cancelled, while in minor surgeries, out of late closure of operation theatre and also in some special-
66 scheduled surgeries, 15 (23%) surgeries were can- ities minor cases were being operated after the resource
celled (Tables 2 & 3). hours. It was observed that 30.65% surgeries were can-
The total resource hours during the observation were celled and lack of operating time because of improper
15,000 min (250 h). The average late start and closure of scheduling was the commonest reason for cancellation
OR was 7 min and 111.04 min, respectively. The total of major surgeries. The reasons for cancellation were sim-
time spent on Banaesthesia preparation time^ was ilar to studies done in the past in India and the commonest
1624 min (8.42%), Bsurgical preparation time^ was reason being lack of operating time leading to improper
1930 min (10.01%), Bactual surgery time^ was 9554 min scheduling [4, 7, 12, 13]. Surgeons were intentionally
(49.56%), Broom set-up time and room clean-up time^ over-scheduling so that no time is wasted if some case
was 4441 min (23.04%), Bsurgery finish time and anaes- gets cancelled due to whatever reasons and the OT time
thesia finish time^ was 574 min (2.98%), Bturn over time^ may be optimally utilized. Cancellation is more in devel-
was 1000 min (5.19%) and Bidle time^ was 156 min oping countries as while trying to utilize the OT fully,
(0.81%) (Fig. 2). intentional overscheduling and duplication in the OT list
The overall total raw utilization was 99.29% and is generally being done to offset the high patient load and
overall total adjusted utilization was 128.53%. The spe- long waiting list for surgery which in turn lead to higher
ciality wise raw and adjusted utilization are shown in cancellation rate [4, 7, 13, 14].
Fig. 3. Authors opine that the preparation and procedure times
in study setting are influenced by the fact that this is a
tertiary care hospital where a substantial effort and time is
Discussion (and should be) dedicated to resident teaching and train-
ing. However, this aspect has not been studied in detail
In our study, the total raw utilization was 99.29% and and might have a bearing on OT time utilization. Detailed
total adjusted utilization was 128.53% which was more study focussing on this particular aspect are required to
as compared to other studies [4, 11]. It was due to the arrive at some definite conclusion.

Fig. 3 Speciality-wise
distribution of raw and adjusted 160 145.01
137.32
utilization 140
129.39
111.9 111.38 113.16 110.82
120 107.37 104.21
96.06
100 86.75 83.04 82.54
78.42
80
60
40
20
0
Surgery ENT Urology Gynaecology Pain Clinic Paediatric GI Surgery
Surgery

Raw Ulizaon (%) Adjusted Ulizaon (%)

 Indian J Surg

The percentage Bturn over time^ in our study was Significant improvements in operating room efficiency
5.19% (1000 min) of the total available resource hours can be achieved by analysing the causes of delays in op-
which is similar to the study done by Talati et al. [4] i.e. eration theatre. Personal accountability, streamlining of
2095 min (5.39%). In a study by Haiart et al. [15], idle procedures, interdisciplinary team work and accurate data
time between cases was 13 h 56 min (4.9% of the allotted collection are all important contributors to improve effi-
time), an average of 3.8 min between individual proce- ciency [18]. Delay in starting the OT on time leads to
dures. However, in our study, the total Bidle time^ was inefficient utilization of available resource hours. This
0.81% (156 min) which was much lesser, as the next can be reduced by improving communication between pa-
patient was called in pre-anaesthetic room before the pre- tient and surgeon and coordination between OT nurses
vious patient was out of OT and simultaneously the trol- and ward nurses for smooth shifting of elective surgery
ley was prepared in the lay-up room for the next case. indoor patients from wards to OT. A dedicated OT man-
Sometimes, the next patient was wheeled inside the OT ager can help plan adequate scheduling of cases, thereby
before the room clean-up was finished and in minor cases reducing cancellation of cases and improving utilization
of surgery, two patients were wheeled inside the OT, of OT [4].
which reduced the idle time. This study has performed an in-depth analysis of the
Total of 28 OT tables were observed in 26 OT obser- various processes and time consumed during the same,
vations of which 23 OT tables started later than the sched- which will help in working on the deficiencies and im-
uled time. Commonest reason was late shifting of the proving the OT efficiency. Processes and time between
patient to the OT (92%) followed by patient not reporting the wheeling in and wheeling out from the OT were
on time to the OT and at times OT was not ready to studied. Hence, any delay in shifting of the patient oc-
receive the patient. The average late start of OR was curring from the ward to OT could not be assessed. The
7 min. However, in a study by Oluwadiyaet al. [16] in a number of OT observations in the study period was lim-
developing country, none of the first-on-the-list cases ited due to fixed time frame; however, the randomisation
started as scheduled in 279 elective cases analysed has led to proportionate and representative sample, lead-
(commonest cause being delayed transfer of patients from ing to reliable representative data.
the wards to the theatre) which was higher as compared to
our study. In a study by Walsh et al. [17], delay in the
arrival of patient in the OT resulted in delayed start of the
theatre (43 out of 46) scheduled cases (93%) which is Conclusion
comparable to our study.
In our study, out of the total 28 OT tables observed in 26 Optimal utilization of operation theatre is the need of
OT observations, 25 OT tables finished later than the sched- the hour and is a key area of interest for all hospital
uled time as minor cases were being conducted by resident administrators, as operation theatre is a resource inten-
doctors after the general anaesthesia time was over which sive facility. Lack of operating time (demand outgrow-
resulted in list over run. The total and overall average late ing the supply) leading to improper scheduling was the
closure of OR were 3109 min and 111.04 min, respectively. commonest reason for cancellation of major surgeries;
In a study by Lewis et al. [1], only two of the 23 lists started on whereas in minor surgeries, outdoor patients not
time (91.3% late starts) leading to overrunning of the lists (13 reporting on the day of surgery was the commonest
out of the 23). reason. All the OTs were over utilized as per the current
Scheduling needs streamlining and improvement, working schedule due to high patient load and long
which can help in bringing down the cancellation rate waiting list for surgery in some specialities. Thus, in
and will also usher in efficiency. Scheduling should not an effort to optimally utilize the OT, over scheduling
include only major cases but also to be done for minor and duplication in the OT list was being done which
cases as well. Scheduling of the same patient in two in turn lead to higher cancellation rate.
different OT lists on same day can be avoided. All
personnel should adhere to the OT timings and should Compliance with Ethical Standards
reach and start OT on scheduled time. Proper pre-
operative check-up of the patients for the surgery to Conflict of Interest The authors declare that they have no conflict of
interest.
avoid last minute cancellations, needs to be
institutionalized.
Indian J Surg

Appendix

Operational definitions as Appendix

Term Definition

Adjusted service utilization (ASU) This measures the percentage of time utilized during resource hours. It is adjusted, compared to raw utilization, in that it
gives “credit” for the time necessary to set-up and clean-up a room, during which time a patient cannot be in the room.
Adjusted utilized resource Hours This provides the percentage of time that the OR’s are being prepared for a patient, are occupied by a patient, or are being
(AURH) cleaned after taking care of a patient during resource hours. It is adjusted, compared to raw utilization, in that it
includes the time necessary to set-up and clean-up a room, during which time a patient cannot be in the room.
Anaesthesia finish time (AF) Time at which anaesthesiologist turns over care of the patient to post anaesthesia care team
(either PACU or ICU). In our setting recovery area.
Anaesthesia induction time (AI) Time when the anaesthesiologist begins the administration of agents intended to provide the level of anaesthesia required
for the scheduled procedure.
Anaesthesia preparation time (APT) Time from anaesthesia start to anaesthesia ready time.
Anaesthesia ready time (AR) Time at which the patient has a sufficient level of anaesthesia established to begin surgical preparation of the patient, and
remaining anaesthetic chores do not preclude positioning and prepping the patient.
Anaesthesia start time (AS) Time when a member of the anaesthesia team begins preparing the patient for an anaesthetic.
Average case length time (ACL) Total hours divided by total number of cases performed within those hours.
Case time (CT) Time from room set-up start to room clean-up finished. It includes all of the time for which a given procedure requires an
OR. It allows for the different duration of room set-up and room clean-up times that occur because of the varying
supply and equipment needs for a particular procedure. For purposes of scheduling and efficiency analysis, this
definition is ideal because it includes all of the time that an OR must be reserved for a given procedure.
Closing time (ClT) Last patient out of room time.
Early start When patient is inside the OR before the scheduled time.
Early start hours (ESH) Hours of case time performed prior to the normal day’s start time when it is not expected that the patient out of room time
will be before the normal start time for that day.
Functional actual hours (FAH) In our study, it is time from actual OR opening time i.e. scheduled OR opening time to actual OR closing time i.e.
scheduled OR closing time.
Functional actual opening hours In our study, it is time from OR opening time i.e. from 07:30 AM the time when the OR starts functioning to actual OR
(FAOH) closing time i.e. scheduled OR closing time.
Idle time (IT) Time from room clean-up finished after the first case to the succeeding patient in room time for
sequentially scheduled cases.
Late start When patient is inside the OR after the scheduled time.
Operating room opening time (OROT) In our study OR opening time is taken from 07:30 AM the time when the OR starts functioning.
Overrun When room clean-up finished, actual, for the last scheduled case of the day is later than room close.
Overrun hours (OVRH) Hours of case time completed after the scheduled closure time of the OR
(i.e. after the end of that day’s resource hours).
Patient in room time (PIR) Time when patient enters the OR.
Patient out of room time (POR) Time at which patient leaves OR.
Planned cases Planned cases are defined as the lists of operations planned to be conducted on a particular day submitted before 17:00 h
on the preceding day to the assistant matron-MOT.
Position/prep start time (PS) Time at which the nursing or surgical team begins positioning or preparing the patient for the procedure.
Prep-completed time (PC) Time at which preparation and draping have been completed and patient is ready for
the procedure/surgery to start.
Procedure/surgery conclusion Time when diagnostic or therapeutic procedures are completed and attempts are being made by the physician or surgical
begun/time (PCB/SCT) team to end any noxious stimuli (e.g. beginning of wound closure, removal of bronchoscope).
Procedure/surgery finish time (PF/SF) Time when all instrument and sponge counts are completed and verified as correct; all post-op radiological studies to be
done in the OR are completed; all dressings and drains are secured; and the physician/surgeons have completed all
procedure related activities on the patient.
Procedure/surgery start time (PST/SST) Time the procedure began (e.g. incision for a surgical procedure, insertion of scope for a diagnostic procedure, beginning
of exam for an EUA, shooting of X-ray for radiological procedure).
Raw utilization (RU) This is the percentage of time that patients are in the room during resource hours.
Resource hours (RH) Total number of hours scheduled to be available for performance of procedures (i.e. the sum of all available block time
and open time). This is typically provided for on a weekly recurring basis, but may be analysed on a daily, weekly,
monthly, or annual basis. For a given institution, this is the time during which an optimum number of appropriate
personnel are available to do cases. This may include more than one shift of personnel, or personnel working extended
shifts (i.e. greater than 8 h), in order to gain vertical expansion of OR hours. It may also include electively scheduled
time on weekends to gain horizontal expansion of OR hours. Resource hours do not include time gained through
overtime or use of on-call personnel, even though this time may be routinely accrued at a given institution.
In our study resource hours are taken from 07:30 AM the time when the OR starts functioning however OT scheduled
working hour’s starts from 8:30 AM onwards to 5:00 PM from Monday to Friday and from
8:30 AM to 1:00 PM on Saturday.
Room clean-up finished time (RCF) Time OR is clean and ready for setup of supplies and equipment for the next case.
Room clean-up start time (RCS) Time housekeeping or room personnel begin clean-up of OR.
 Indian J Surg

Room clean-up time (RCT) Time from patient out of room/room clean-up start to room clean-up finished.
Room gap time Time ORs are vacant during resource hours.
Room ready time (RR) Time when room is cleaned and supplies and equipment necessary for beginning of the first case/next case are present.
Room set-up start time (RSS) Time when personnel begin setting-up, in the OR, the supplies and equipment for the first case/next case.
Room set-up time (RST) Time from room set-up start to room ready.
Scheduled operating room time (SORT) In our study the scheduled OR start time was taken as 08:30 AM and scheduled OR closing time was taken as 5 PM
from Monday to Friday & was taken as 1 PM on Saturday.
Start time (StT) For maximizing scheduling accuracy and attempting to encourage the most efficient patient flow, the authors have
elected to define start time as patient in room time.
Surgery time (ST) Time from surgery start time to surgery conclusion time.
Surgical preparation time (SPT) Time from position/prep start to procedure/surgery start time.
Turnover time (TOT) Time from prior patient out of room to succeeding patient in room time for sequentially scheduled cases.
Major surgery Any surgical procedure done under general anaesthesia, regional anaesthesia or both.
Minor surgery Any surgical procedure done under local anaesthesia.

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